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Dr. Steven Hersch explains concierge medicine outside his office near Ashland Community Hospital Monday. - Troy Goossen

Ashland doc changes practice to concierge care

Frustrated by excessive insurance regulations, lean reimbursements and the brief visits they allow with patients, Dr. Steven L. Hersch of Ashland is changing his practice to concierge care, in which his patients pay an annual membership fee but receive extended visits, ongoing preventive care and a chance to talk to him by phone or email.

For a retainer of about $100 a month, Hersch remains accessible, gets to know his patients' lifestyles, and develops plans for their diet and exercise, taking genetic and family history into account.

"It provides the level of care and service I would want," said Hersch, who worked 13 years in a five-doctor practice in Los Angeles and did hospital work for 10 years with Rogue Valley Medical Center. "Not a lot of doctors are doing close, attentive care, but I want to do it."

Concierge care allows a doctor to give more attention to fewer patients, Hersch said. Increasingly complex insurance reimbursements restrict the amount of time doctors can spend on procedures, he said, resulting in "doctors seeing more patients for less time" with less quality care.

Sen. Alan Bates, a Medford physician and architect of much of the state's recent health legislation, disparaged concierge care, a growing trend among doctors nationwide.

"It's good for doctors and, if they can afford it, for patients," Bates said. "But 99 percent of them can't afford it. What it says is you get special care. It's cherry-picking and what you, the patient, are getting is your own personal doctor."

The practice, Bates added, would shrink the insurance risk pool and "lead to a disintegration of the system over time ... only the wealthiest people would be attracted to it. I don't personally agree with the philosophy."

Bates said membership medicine isn't affordable to low-income and middle-class people and is a "system of specialized care that you usually have to do in affluent areas."

Betsy Boyd-Flynn, chief operating officer of the Oregon Medical Association, said the system is just getting started in Oregon and she knows of only a few doctors who are providing it. A quick search online showed a few Portland doctors and one in Bend advertising concierge care, also called membership care.

"I don't have enough data from Oregon to give you a range, but I've heard of anecdotes from other states about multi-thousand-dollar annual fees; DCBS (Oregon Department of Consumer and Business Services) data in 2010 showed fees were averaging $125-$200 per month.

"It reflects what doctors have to do to stay in practice and take care of patients," said Boyd-Flynn. "The profession is in a very stressed place, from a number of directions, and the doctors are right in the middle."

Costs and limited insurance reimbursements "means we can't be counseling for obesity, for example. That's not in health plans," she said, adding that the present medical system carries "perverse incentives and is a system of fixed care, not wellness."

Under the present system, physicians don't get to explore and ask questions such as, "Do they have healthy foods and can they walk for exercise, outside, freely and safely?" she said.

Boyd-Flynn said concierge care may prove attractive to patients without health insurance or those with minimal care needs or a medical savings account.

Hersch calls his practice "Meducation" and operates out of a home on Chestnut Street near Ashland Community Hospital. He employs only an office manager and does all nursing tasks himself. His patients still carry insurance, which can be used for specific in-office procedures covered by the thick book of rules and reimbursements from the insurer.

Patients' membership allows for a range of other things a doctor can do to make a "holistic plan of prevention and treatment" that may include research and consultations with alternative healers.

Hersch, in a flier to patients, said he tried concierge care without fee for three years, but insurers wouldn't pay for any extra time he invested in patients.

He acknowledged the cost will mean some patients may leave, but members will all be treated fairly and equally, with equal payments for services, regardless of pre-existing conditions.

Hersch said membership care may reduce overall costs for people with multiple or ongoing health issues and covers anything not covered by insurance.

He has "a couple hundred" patients and is not taking new patients, except as spaces are created by people opting out of the membership care plan.

John Darling is a freelance writer living in Ashland. E-mail him at jdarling@jeffnet.org.

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